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. 2025 May;97(6):1989-1996.
doi: 10.1038/s41390-024-03564-y. Epub 2024 Sep 16.

Resuscitation arterial waveform quantification and outcomes in pediatric bidirectional Glenn and Fontan patients

Andrew R Yates  1 , David A Hehir  2 , Ron W Reeder  3 , John T Berger  4 , Richard Fernandez  5 , Aisha H Frazier  6 , Kathryn Graham  2 , Patrick S McQuillen  7 , Ryan W Morgan  2 , Vinay M Nadkarni  2 , Maryam Y Naim  2 , Chella A Palmer  3 , Heather A Wolfe  2 , Robert A Berg  2 , Robert M Sutton  2 ; ICU-RESUS; Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network Investigator Groups
Collaborators, Affiliations

Resuscitation arterial waveform quantification and outcomes in pediatric bidirectional Glenn and Fontan patients

Andrew R Yates et al. Pediatr Res. 2025 May.

Erratum in

Abstract

Background: Resuscitation with chest compressions and positive pressure ventilation in Bidirectional Glenn (BDG) or Fontan physiology may compromise passive venous return and accentuate neurologic injury. We hypothesized that arterial pressure and survival would be better in BDG than Fontan patients.

Methods: Secondary analyses of the Pediatric Intensive Care Quality of CPR and Improving Outcomes from Pediatric Cardiac Arrest databases. P-values were considered significant if < 0.05.

Results: In total, 64 patients had either BDG (42/64, 66%) or Fontan (22/64, 34%) anatomy. Return of spontaneous circulation was achieved in 76% of BDG patients versus 59% of Fontan patients and survival with favorable neurologic outcome in 22/42 (52%) BDG versus 6/22 (27%) Fontan patients, p = 0.067. Twelve of 24 (50%) BDG and 2/7 (29%) Fontan patients who survived to discharge suffered new morbidity as defined by worsening Functional Status Score. More BDG patients achieved adequate DBP (≥25 mmHg for neonates and infants; ≥ 30 mmHg for children) than Fontan patients (21/23 (91%) vs. 5/11 (46%), p = 0.007).

Conclusions: Only 27% of Fontan patients survived to hospital discharge with favorable neurologic outcome after CPR, likely driven by inadequate diastolic blood pressure during resuscitation. One half of the BDG patients who survived to hospital discharge had new neurologic morbidity.

Impact statement: Hemodynamic waveforms from 2 large prospective observational studies now allow for exploration of physiology during cardiopulmonary resuscitation for unique anatomy associated with single ventricle congenital heart disease. Fewer patients with Fontan physiology (46%) achieved an adequate diastolic blood pressure (defined as ≥ 25 mmHg for neonates and infants and ≥ 30 mmHg for children) than bidirectional Glenn patients during cardiopulmonary resuscitation (91%, p = 0.007). Only 27% of Fontan patients survived to hospital discharge with favorable neurologic outcome after cardiopulmonary resuscitation. Of the bidirectional Glenn patients who survived, 50% developed a new morbidity as quantified by the Functional Status Score.

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Conflict of interest statement

Competing interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper other than the financial support from the NIH. Supported, in part, by the following cooperative agreements from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services: UG1HD050096, UG1HD049981, UG1HD049983, UG1HD063108, UG1HD083171, UG1HD083166, UG1HD083170, U01HD049934 and R01HL131544 from the National Heart lung and Blood Institute. Patient consent statement: Patient consent was not required for this study. Both PICqCPR (July 2013–June 2016) and ICU-RESUS (October 2016–March 2021) were approved by the central IRB at the University of Utah with waiver of informed consent.

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